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Colorectal Diseases

Post-perirectal abcess surgery

03/23/2006

Question:

I had surgery about 8 yrs ago for a peri-rectal abcess that was about softball size. It first presented itself with a continuous temp and horrible pain. I was unable to sit or lie down without extreme pain. My doctor could not palpate the mass from the outside. I was hospitalized and a surgeon called in who performed immediate surgery. I went to physical therapy for several weeks for wound care before I was able to return to work. A tiny slit like area remained that never quite healed over. Within about a year a small bump formed in this slit area and for the past eight years has at times drained a minimal ammount of blood or pus. A hard ridge like area also developed into the anal wall that I have been able to feel all the time especially when I have a BM. I have had hemarroids continuously since the surgery. I have taken a sedentary job and am now sitting at the computer a great deal of time which causes the area to be painful and more noticeable. I have always had bleeding from the hemorroid area and now a small ammount of blood from the bump. I run no fever, try to keep my bowel movements softened so I won`t irritate the area. Is this a fissure I am feeling and can palpate? Can it be aspirated by the surgeon without surgery? I am terrified of another surgery and at this time I do not have major medical insurance. When the area has flared up in the past I have had some antibiotic tx`s, and usually take epsom salt baths to relieve it and it has been effective. I have had some mucous in my stools but I have associated this with constipation.

Answer:

The history you describe is consistent with a fistula-in-ano, which develops in around 70% of patients with an anorectal abscess. You should visit with a colon and rectal surgeon (find one at www.fascrs.org) , who deals with these conditions on a daily basis, to discuss your options for treatment. More surgery is likely to be the best answer to give you a permanent fix; your prior experience should not dissuade you from seeking care. Before, you were obviously sick and in a great deal of pain. Now you are healthy i assume, and your treatment less urgent. Good luck!

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati